Charles A Shepard, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

21197 Issued in MN

Practice address

859 Mankato Ave
Winona, MN 55987

Phone

(507) 454-3680

Fax

(507) 457-7672

NPI assigned

Aug 8, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Winona Health Services

  • General Acute Care Hospital
  • Winona, MN
  • NPI 1295789352
  Medicare reassignment NPD
• Shapard Anesthesia Medical Group Inc

  • Anesthesiology Physician
  • Rancho Mirage, CA
  • NPI 1144393059
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154995200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1477563179",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "859 MANKATO AVE",
            "address_2": "WINONA CLINIC LTD",
            "city": "WINONA",
            "state": "MN",
            "postal_code": "55987",
            "telephone_number": "507-454-3680",
            "fax_number": "507-457-7672"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "859 MANKATO AVE",
            "city": "WINONA",
            "state": "MN",
            "postal_code": "55987",
            "telephone_number": "507-454-3680",
            "fax_number": "507-457-7672"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHEPARD",
        "first_name": "CHARLES",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-08",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MN",
            "license": "21197",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amber Shanrock
• Alexandra Sharp, MD
• Samantha Reggi Shea, MT
• Debbie Ann Sheets, MS, RN, LICSW, CEAP
• Troy J Shelton, MD
• Carly Ann Sherod, DDS
• Katelyn Holly Sherpe
• Cody Shimota
• Shopko Stores Operating Co LLC
• Shopko Stores Operating Co. LLC

• Internal Medicine Physician in Winona, MN
• Providers in Winona, MN by specialty
• Internal Medicine Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.